Dr. Khasawneh is an internal medicine resident, and Dr. Thomas is an assistant program director, Internal Medicine Residency Program; both are at Westlake Hospital, Melrose Park, IL.

The questions below are based on the article Accidental Hypothermia.

Choose the single best answer for each question.

1. A 76-year-old nursing home resident is found unresponsive in his room in July. A nurse had last seen him watching television the previous evening. The patients past medical history is significant for hypertension and a stroke, which rendered him aphasic and bed-bound for the past 3 months. On examination, the patient is unresponsive to painful stimuli. His blood pressure is 110/70 mm Hg, heart rate is 51 bpm, temperature is 30°C, and respiratory rate is 10 breaths/min. What is the most likely cause of this patients hypothermia?

2. A 35-year-old man is found undressed under the stairs of an abandoned building in January. Upon initial evaluation, the patients heart rate is 40 bpm, and his blood pressure is 100/50 mm Hg. A temperature could not be recorded by rectal thermometer. There are no signs of trauma. Which of the following initial management options should be avoided in this patient?

3. A 60-year-old homeless man is brought to the emergency department by the emergency medical services team. He was found in asystole in the field where resuscitative efforts were initiated 30 minutes ago. Initial evaluation reveals no heart rate, and a temperature of 27°C is recorded by a bladder probe. According to ACLS guidelines, cardiorespiratory resuscitation efforts should not be terminated until the core body temperature is at least which of the following?

6. An 80-year-old woman is found unresponsive at home. During initial evaluation, temperature could not be recorded by oral thermometer. The patient opens her eyes to noxious stimulus. Which of following signs suggests severe hypothermia?

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